There is an ever-increasing effort in health care to develop techniques and approaches that would be less traumatic to the patient. Accordingly, minimally and non-invasive surgical techniques are an active area of interest. For example, techniques such as extracorporeal shock wave lithotripsy have resulted in significantly reduced morbidity in the treatment of renal calculi and have also resulted in greatly improved outcomes to the patient. Emerging technologies, such as image-guided therapies, that involve High Intensity Ultrasound and High Intensity Focused Ultrasound (HIFU) are also becoming increasingly integrated in the armada of tools available to the modem medical clinician.
In one important procedure described in U.S. Pat. No. 6,007,499 (of which the present application is a continuation-in-part), it is demonstrated how the application of HIFU to a section of tissue can introduce a plane of cauterization within the tissue, thus permitting the subsequent resection of the tissue, distal to the plane, without bleeding.
In the U.S. alone, several hundred thousand surgical procedures are performed each year that involve the removal of tissue, or a portion of an organ, because of some pathology involving the tissue. Many of these procedures remove benign or malignant tumors. Although a significant percentage of such tissue and organ removal procedures employ conventional surgical techniques, a major effort has been directed to replacing (as much as possible) conventional surgical techniques with minimally invasive surgical techniques (such as laparoscopic and endoscopic techniques), to reduce morbidity. However, performing such surgery using minimally invasive instruments requires significant training and advanced skills on the part of the operating physician. It would be desirable to provide minimally invasive methods and apparatus that are relatively easier to implement than those currently used.
Almost 400,000 patients were treated for end-stage renal disease (ESRD) in the United States in 2001. The incidence of new beneficiaries of treatment was in excess of 93,000 individuals during the same calendar year, and the mortality attributed to ESRD was well over 76,000 during that year. Many of these individuals are candidates for kidney transplants; however, the demand far exceeds the number of kidneys available for transplant. Thus, clinicians are making efforts to preserve as much of a kidney as possible during renal surgical procedures. Considerable effort has been made to train urologists and surgeons to perform partial nephrectomies during laparoscopic procedures. A laparoscopic partial nephrectomy is a particularly difficult procedure, primarily because it is difficult to prevent and control bleeding during and after the procedure. It is common during a laparoscopic partial nephrectomy to clamp the main renal artery so that tissue removal can be carried out without significant bleeding. If this renal artery is clamped for an excessive time, ischemia can cause long term damage to the remaining tissue.
It would thus be desirable to provide methods and apparatus to facilitate surgical procedures with minimal blood loss, which can be used for laparoscopic partial nephrectomies, as well as for other surgical procedures.